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BASE HOSPITAL GROUP ONTARIO Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation- Ontario Base Hospital Group Education Subcommittee.

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Presentation on theme: "BASE HOSPITAL GROUP ONTARIO Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation- Ontario Base Hospital Group Education Subcommittee."— Presentation transcript:

1 BASE HOSPITAL GROUP ONTARIO Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE

2 OBHG Education Subcommittee Introduction to 12 Lead Interpretation REVIEWERS/CONTRIBUTORS Neil Freckleton, AEMCA, ACP Hamilton Base Hospital Jim Scott, AEMCA, PCP Sault Area Hospital Ed Ouston, AEMCA, ACP Ottawa Base Hospital Laura McCleary, AEMCA, ACP SOCPC Tim Dodd, AEMCA, ACP Hamilton Base Hospital Dr. Rick Verbeek, Medical Director SOCPC 2008 Ontario Base Hospital Group AUTHOR Greg Soto, BEd, BA, ACP Niagara Base Hospital

3 OBHG Education Subcommittee Chapter 6 - Objectives  Recognize the usefulness of ECG data provided by computerized 12 Lead ECG  Identify important features of ECG such as Q, R, S, T waves and relate to 12 Lead interpretation  Find J-points and compare to TP segments  Recognize ST-elevation and relate to clinical significance  Become comfortable with recognizing and locating AMI on 12 Lead ECG  Practice a bit of 12 Lead interpretation

4 OBHG Education Subcommittee 12 Lead Interpretation  Interpretation vs. STEMI Recognition It is important to note that upon completion of this training, it is not expected that paramedics will be “interpreting” a 12 Lead but rather recognizing STEMI patients

5 OBHG Education Subcommittee Learning 12 Lead ECG Interpretation Common Paramedic responses prior to learning 12 Lead ECG Interpretation:  I can’t interpret a 12 Lead ECG like a Cardiologist!  Are you kidding me? Common Paramedic responses after learning 12 Lead ECG Interpretation:  Hey – that wasn’t as hard as I thought it would be!

6 OBHG Education Subcommittee Essential Interpretation  Goals Recognize and localize AMI on the ECG Feel comfortable with 12 Lead interpretation

7 OBHG Education Subcommittee 12 Lead ECG

8 OBHG Education Subcommittee 12 Lead ECG

9 OBHG Education Subcommittee 12 Lead ECG

10 OBHG Education Subcommittee R Wave

11 OBHG Education Subcommittee Q Wave

12 OBHG Education Subcommittee S Wave

13 OBHG Education Subcommittee J-Point

14 OBHG Education Subcommittee ST Segment

15 OBHG Education Subcommittee  J point - end of QRS complex & beginning of ST segment The J Point

16 OBHG Education Subcommittee Practice  Find J-points and ST segments

17 OBHG Education Subcommittee Practice  Find J-points and ST segments

18 OBHG Education Subcommittee 12-Lead ECG  AMI recognition Two things to know What to look for Where to look Local medical oversight will determine the criteria used to identify a STEMI patient. All stakeholders must be consulted to determine what criteria should be utilized in a given centre.

19 OBHG Education Subcommittee What to look for  Example - ST segment elevation One millimetre or more (one small box) in limb leads Two millimetres or more (two small boxes) in chest leads Present in two anatomically contiguous leads

20 OBHG Education Subcommittee Contiguous Leads  Limb leads that “look” at the same area of the heart OR  Numerically consecutive chest leads

21 OBHG Education Subcommittee Contiguous Leads  Inferior wall: II, III, avF  Lateral wall: I, aVL, V5, V6  Septum: V1 and V2  Anterior wall: V3 and V4  Posterior wall: V7, V8, V9 (leads placed on the patient’s back 5 th intercostal space creating a 15 lead EKG)

22 OBHG Education Subcommittee Where to look  ST segment elevation measurement 0.04 seconds after J point

23 OBHG Education Subcommittee ST Segment Elevation

24 OBHG Education Subcommittee ST Segment Elevation  Presumptive evidence of AMI  Indication for acute reperfusion therapy

25 OBHG Education Subcommittee ST Segment  Compare to TP segment STTP

26 OBHG Education Subcommittee ST Segment Analysis

27 OBHG Education Subcommittee Practice

28 OBHG Education Subcommittee Lead “Views”

29 OBHG Education Subcommittee Limb LeadsChest Leads IaVRV1V4 IIaVLV2V5 IIIaVFV3V6 Lead Groups

30 OBHG Education Subcommittee Lead “Views”

31 OBHG Education Subcommittee Inferior Wall  II, III, aVF Left Leg I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

32 OBHG Education Subcommittee Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

33 OBHG Education Subcommittee Lateral Wall  I and aVL Left Arm I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

34 OBHG Education Subcommittee Lateral Wall  V5 and V6 Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

35 OBHG Education Subcommittee Lateral  I, aVL, V5, V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral Wall

36 OBHG Education Subcommittee Anterior Wall  V3, V4 Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

37 OBHG Education Subcommittee Anterior Wall V3, V4V3, V4 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

38 OBHG Education Subcommittee Septal Wall  V1, V2  Along sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

39 OBHG Education Subcommittee Septal V1,V2V1,V2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

40 OBHG Education Subcommittee AMI Localization Anterior: V3, V4 Septal: V1, V2 Inferior: II, III, AVF Lateral:I, AVL, V5, V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

41 OBHG Education Subcommittee AMI Recognition I Lateral II Inferior III Inferior aVR aVL Lateral V1 Septal aVF Inferior V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral

42 OBHG Education Subcommittee AMI Recognition  Know what to look for ST elevation > 1mm in limb leads > 2mm chest leads Two contiguous leads  Know where you are looking You will soon have this memorized

43 OBHG Education Subcommittee Mnemonic for Location  Rhyme, phrase or device for remembering something  “LII – LI – ASS (backwards) – ALL” L = I (Lateral) I = II (Inferior) I = III (Inferior) L = aVL (Lateral) I = aVF (Inferior) S = V1 (Septal) S = V2 (Septal) A = V3 (Anterior) A = V4 (Anterior) L = V5 (Lateral) L = V6 (Lateral)

44 OBHG Education Subcommittee Using mnemonic on ECG  You may want to write the Letters in the corner of each Lead when interpreting L LL L I II S S A A

45 OBHG Education Subcommittee Antero Septal

46 OBHG Education Subcommittee Extensive Anterior

47 OBHG Education Subcommittee Inferior

48 OBHG Education Subcommittee Extensive Anterior

49 OBHG Education Subcommittee Inferior

50 OBHG Education Subcommittee Extensive Anterior

51 OBHG Education Subcommittee Normal ECG

52 OBHG Education Subcommittee Inferior

53 OBHG Education Subcommittee Infero-lateral

54 OBHG Education Subcommittee Inferior

55 OBHG Education Subcommittee Inverted T-waves = ischemia

56 BASE HOSPITAL GROUP ONTARIO QUESTIONS?

57 BASE HOSPITAL GROUP ONTARIO Well Done! Education Subcommittee STARTQUIT


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